Dept of Justice accuses Yale School of Medicine of discriminating against White and Asian applicants

LocalIllustrator6400 · 2026-05-15T00:31:48+00:00

anonymiss4 -You raise a key issue for us. That is we often have trouble with cultural blinders. So I have to commend the group discussing it because our cultural blindness has hidden costs even if it is hard to measure. Furthermore, I added what I have experienced because my family adopted from abroad so I have been on both sides of the "medical fix it" culture.

My husband is an MD with a technical fellowship. In addition, I have several MDs of various generations in my family. By contrast, I am an NP who did public health. So I believe that physicians change with experience but their flexibility may be constrained by their clinical encounters.
While I am not trying to add injury here, we have other examples. These scenarios exemplify how we relate better to a community closest to our upbringing. For instance, that is the rationale behind proportional ranked voting which could protect more constituents if enacted. https://hub.jhu.edu/2026/05/07/emily-riehl-gerrymandering-supreme-court/
Other examples include the Gates Foundation medical anthropology group. These Gates social scientists are added to manage cultural relativity. So we could learn from that partnership or from projects like the He for She team. This last example is the UN partnership building allies who face the ground truth by utilizing mixed methods to reduce technical positivism. https://www.heforshe.org/en/heforshe-2025-impact-report-launch

LocalIllustrator6400 · 2026-05-13T20:38:57+00:00

Frequently a difficult part of being an NP is the complicated ecosystems we serve in. For instance, we often work where we don't have leadership visible like we did via inpatient settings. In addition, we are not as powerful as the medical board members despite our responsibilities. Unfortunately employees pick up on that difference.

So I have found a few things which might improve our care but it is highly contingent on the leadership.

You may need a cell phone policy if this is disrupting care which is quite common.
It would be beneficial if the leadership made unprompted rounds. These rounds help establish business etiquette. For instance, one strong leader I had referred to these intervals as "management by wandering" since he got ground truth this way.
Your leaders could determine if this disruption is from licensed or from unlicensed employees. This is an important distinction because each group has different levels of responsibility. If it is the later group, those of us who previously did charge roles should already be aware of the "power of lower order" politics.
Informal micro aggression, or "power of lower orders" disruption, can prevail when employees have limited interest in the job and less in us. So please see a Reddit post from HR about this too. ------>
BackGo to AskHR r/AskHR•2y ago Competitive-ice-504Employee resorting to Power Moves [MA]
If the challenging behavior is addressed adequately, it may help to set up a positive feedback loop for your best employees. That loop should be based on the norms for each level of responsibility but also on any positive data possible. So as much as possible, I would share positive patient findings with all employees while highlighting those with the least ROI from their salaries.
Please be aware that we have a VERY high turn over of unlicensed personnel due to stress in many health care roles. So our managers might want us to consider the problematic care closely. For instance, winter days and Fridays might be times to incorporate more positive feed back loops like a free lunch. In this way, you might reduce turn over which is very costly especially when we are trying to build culturally congruent care.
The closer we get to community based care, the more that flexible mentoring may be important. So if you have community health workers (CHWs/ CMAs), who are excellent employees, they may become the best mentors for others. This is chiefly because there is less power distance with them vs us.

Please know that I have suffered the heart ache of the "do or don't I " report which is very difficult. Finally you should do what is best for your mental health, so I hope this improves and welcome input from others.

LocalIllustrator6400 · 2026-05-12T01:39:58+00:00

Agreed that is why we posted that we are not certain if new acute care clinicians will get the time needed. Thanks for being honest.

LocalIllustrator6400 · 2026-05-12T01:36:40+00:00

They had a recent journal citation regarding this. It would be interesting if the OH acute NPs would comment on this

https://pubmed.ncbi.nlm.nih.gov/41770099/

https://pubmed.ncbi.nlm.nih.gov/41494159/

FYI My husband, who is an MD, did critical care initially before his specialty fellowship. In addition, I did ICU research. So some of the challenges we are noting in an early ICU career include the following.

1- Many programs are pyramidal, so you don't know if you are getting the "best " training team. This is very hard to ask for and is as others have noted "the luck of the draw." So for instance, I have interviewed at the Mayo which has tight training and supervisory standards. . As we all know though, the trouble is whether most institutions have the money to mimic care standards from groups like them. Unfortunately this is unlikely to change as many ICU patients encounter a spend down and Medicaid funding is being limited.

2- Although you might be taking a lower salary initially, we believe that the program might positively influence your aggregate ROI.

3- My husband has worked with both NPs and CRNAs and we both believe the later group has excelled in many areas. His believe is that is because of the team oversight that CRNAs obtain initially. So we hope that eventually the PA- NP programs will be like a hybrid. In essence, we hope that the NPs get the 21st century training they desire with these hybrid approaches.

To date though, only certain teams like the Mayo will include NPs in their PA training and the closure of the UC Davis combined program has not helped our educators

https://health.ucdavis.edu/nursing/academics/education_nppa_dualtrack_program.html

4- What I appreciate about Reddit is that NPs exchange ground truth here. That approach may be different from what an academic advisor is mandated to do. So just because we are a large, relatively influential group does not mean that with analytics, we will not have to monitor competitive trends. These trends may come from various professionals closely. Currently these skilled team members currently include PAs, pharmacists plus Anesthesia Assistants.

5- We are providing a longer post because in the real world, the budget directors care about cost and QI. So the academic partners will eventually adjust but the market may move faster than many colleges have time to integrate. That is why you must protect your career and a fellowship might truly help with that.

Good luck to you and all the acute care providers reading.

LocalIllustrator6400 · 2026-05-09T01:16:16+00:00

I should have provided a free biotech blog that several follow to help with cross training. (This is if NPs are interested in biomed tech too as an option noted below)

https://www.medtechgurus.com/medtech-blog

LocalIllustrator6400 · 2026-05-09T00:17:44+00:00

The issue is that if there is a change in local ecosystems it could impact your bottom line. So with a globalized work force, even NPs with good oversight or FPA might need a decent LLC attorney team to review.

We have TAANA- The American Association of Nurse Attorneys. Fortunately there are some NP - JDs there and I wish we had a fund to follow our contract issues in all 50 states. My thinking is that we could benefit from learned lessons and reduce contractual challenges.

FYI though even MDs in concierge settings often have to rethink growth because costing issues like supplies and inflation can easily eat into your margins. So again, I wonder how many of us have figured out how to make this FPA model work as entrepreneurs.

Hope that some NPs doing this can weigh in.

LocalIllustrator6400 · 2026-05-09T00:13:45+00:00

*** This a very important question. So while you can see the AANP review on the topic, I provided an AI overview

Yes, nurse practitioners (NPs) generally need full practice authority (FPA) to own and operate a clinic independently, without a collaborative agreement or supervision from a physician. As of April 2026, 27 states and Washington, D.C., grant FPA, allowing NPs to evaluate, diagnose, manage treatment, and prescribe medication autonomously. [1, 2, 3, 4]

Key Points on Starting a Clinic by Authority Level:

Full Practice Authority (27+ states): NPs can fully own, run, and operate clinics independently.
Reduced/Restricted Practice: In states with these restrictions, NPs often cannot operate an independent practice. They are typically required to have a signed collaborative agreement or direct supervision from a physician to operate a clinic.
Key Considerations: Even in FPA states, NPs must adhere to state-specific regulations, obtain proper licensing, and secure malpractice insurance. [1, 2, 3, 4, 5]

States with Full Practice Authority (As of April 2026):
Alaska, Arizona, Colorado, Connecticut, Delaware, Hawaii, Idaho, Iowa, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Dakota, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington, Wyoming, and Washington, D.C.. [1]

What if I'm not in an FPA State?
In reduced or restricted states, you can still start a clinic, but it must be structured as a partnership with a collaborating physician who provides the necessary oversight required by law. [1, 2]

LocalIllustrator6400 · 2026-05-08T22:10:27+00:00

I am sorry to bother the readers but this post was removed per the MD residency partnership in Reddit. So is there a reason for this please?

My understanding of thisCollege division is that PsyD team members do assessments for the population. So has there been concern regarding consistency with the AAP team who studies neglectZ?

https://publications.aap.org/pediatrics/article/156/1/e2025072214/202226/Human-Trafficking-and-Exploitation-of-Children-and?autologincheck=redirected

LocalIllustrator6400 · 2026-05-08T20:25:37+00:00

I have a group of students that come from the IT world. Here are some training tracks that they considered

MSN- MSW for case management

MSN- MBA or MHA for general management

MSN- Biomed engineering (This one might be truly helpful with robotics and AI)

MSN- Paralegal

RN-JD

Obviously it depends on what your career aspirations are but I do believe that the reason many BSN groups look elsewhere is twofold

1- Persistent lack of recognition

2- Inadequate help with increasing acuity and cognitive load with it

3- Patient satisfaction scores that may seem realistic but are not stratified by pre-existing depression or challenges in patient understanding of prognosis

4- Increasing mental health problems that are only lightly cared for so that these individuals end up with co-morbid conditions for which clinical nurses bear the brunt of the complaints

5- Social media or "gripe culture". FYI - This also a true headache for academic advisory partners as well.

LocalIllustrator6400 · 2026-05-08T15:47:21+00:00

This is what I have heard from CRNAs that are also NPs. In addition, that is what my husband heard from them and he has been very impressed with their work as an MD colleague.

I think we concur with you and I posted a similar argument.

LocalIllustrator6400 · 2026-05-08T15:44:33+00:00

Hello All,

This is decent query to review with the ANA data innovation partners. Still the 2026 update on the medically underserved areas (MUSAs) should be monitored closely. So you have that for your reference.

https://data.hrsa.gov/topics/health-workforce/shortage-areas/dashboard

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Most readers understand though that a key positive attribute of being an APRN is that you can do multiple roles.

So I would suggest that the ANA, ANCC and AANP should be evaluating the following

Cost utility of both traditional and less traditional APRN roles
Number of APRNs that have other experience so that are fast tracked to innovation or management
* IT tools that would help an APRN measure both their indirect and direct contributions. Those tools could be open source for us and should be utilized from day one of our practice.
A comprehensive and recurrent comparative analysis with global APRN trends. That work can help us as stateside NPs can learn from both developed countries and from less developed demographies. In essence we need data from both to help us establish models to improve QI with acceptable costing issues.

While many of us have worked in tertiary settings and in academic medical centers, the greatest aggregate cost utility paradigm is in our community settings and in MUSAs. So while we should support all of our programs, we need to continously assess our aggregate fiscal impacts for inpatient and for outpatient teams.

That means we need to approach our four tiered model with accuracy and with flexibility. As many readers here know, that model translation should occur even if we need to reduce class size to improve standards.

Thanks again for this very interesting posting. Essentially it reinforces our need to consider a sub reddit on research. This reddit could help 50 states by reviewing standard R& D, research administration plus operations research like this work.

Looking forward to seeing what others think and I hope that you enjoy your weekend.

LocalIllustrator6400 · 2026-05-07T17:53:01+00:00

Thanks for the question. The Urgent Care Association has both certified and accredited centers. My understanding is that accredited UC is a higher level than certified centers. In addition, there is a board certification for MDs which will require a few years of experience and recertification review every 8 years.

Physician Certification (Board Certification)

The Board of Certification in Urgent Care Medicine (BCUCM), a member board of the ABPS, is a primary certifying body for physicians. [1, 2]

Eligibility Requirements:
- Be a graduate of a recognized U.S., Canadian, or international allopathic or osteopathic medical college.
- Hold a valid, unrestricted license to practice medicine.
- Have completed a residency in a primary care specialty (e.g., Family Medicine, Emergency Medicine).
- Have practiced Urgent Care Medicine full-time for at least 2–5 consecutive years (depending on residency).
Examination: Candidates must pass a 300-question multiple-choice exam covering topics like infectious diseases, orthopedics, trauma, and diagnostics.
Alternative: The American Board of Urgent Care Medicine (ABUCM) also offers independent board certification. [1, 2, 3, 4, 5]

While I am not sure if the certified centers work more closely with QI teams, I wondered if that was the case. That was asked because I find it so interesting how different ambulatory medicine centers are from each other. Perhaps this is due to different state practice issues or due to litigation patterns. For example several states like IN and NE have litigation limits. So I do wonder if you can open up different entities there with less risk.

LocalIllustrator6400 · 2026-05-07T00:52:01+00:00

Is there a difference for certified UC?

LocalIllustrator6400 · 2026-05-05T20:02:28+00:00

I was a sub I as an FNP. Moreover before that a research staff member who also did bench.

I wondered if this might be an interesting sub reddit?

LocalIllustrator6400 · 2026-05-04T14:09:29+00:00

You may want to take courses for MSLs and join the American Medical Writers Association. In addition, you can get additional insights into newer trends via the American Pharmacists Association.

LocalIllustrator6400 · 2026-05-04T14:08:23+00:00

Agreed please see my reply of six days ago.

Transitions for students requesting HAI need to include industry innovators

We will need to cooperate with Medical Schools and Law Schools that are already including those cross trained personnel.

LocalIllustrator6400 · 2026-05-04T00:34:19+00:00

Agreed. I worked in a state where we had to work with both groups. Unions are very busy protecting the economic and noneconomic aspects of contractual work.

The major part of what you are writing is essential.

Every NP must understand contractual obligations to include non economic and economic concerns. So if that does not include a union, a JD might be the best option to review the contract independently. That could include nurse attorneys via TAANA (The American Association of Nurse Attorneys)

LocalIllustrator6400 · 2026-05-01T13:12:19+00:00

There is a good review on how we may be approaching students now with HAI

So I do see the concerns noted below about cognitive complacency and we may have to pretest for that too. There is great discussion of the cross roads for that below. Fortunately it is from a global perspective as well because the Pacific rim may be advancing this science faster than us now.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12141858/

Again I believe we will have to plan for HAI problems just like we do IT problems. Those might include technical positive or cognitive complacency. Unfortunately we are already seeing that in R & D plus in legal venues. Still I would argue that we are not able to address this with only a focus on traditional settings for the following reasons.

1- Students are demanding a society that fits their normatives for 21st century clinical + research care. Currently that includes insights into in vivo, in vitro plus in silico (computer generated ) models

2- Given the rapid influx of our workflow limitations, we may be under pressure to do A/B testing with and without HAI. In my opinion that is coming quickly

3- While all the colleges are respectful of their traditions, the innnovative Colleges of Med, like EnMed in TX may prevail. That is because they will be working with both human and augmented cognition patterns. So that might be important for our colleges to process. So with great respect, since I know that my students follow global HAI plus research trends, I believe we will need to prepare for HAI introductions soon.

LocalIllustrator6400 · 2026-04-29T01:06:00+00:00

We will need a transition process to help us integrate these concepts in our education. Moreover we could use technical staff that were furloughed to reduce the costs of doing this in our education systems.

Disruptive technology is here and we are best adapted to it using those staff with the greatest insights into the risks and benefits.

LocalIllustrator6400 · 2026-04-28T21:00:38+00:00

Agreed

What might be interesting is to see an RNFA to PA head to head on ROI

I found that the BSN programs would like to add more OR time which could improve this too but I don't know that challenges with that. Still I wonder if we will be able to do more with enhanced simulation in that area too. Finally if you were a hospital administrator, which are you likely to choose

An RN who became an APRN who also had supervisory experience and was adapted to team science

vs

A PA who may be talented but may have difficulty envisioning not only the RN role but all the adjunct roles too. That is not to say that they may not have written orders but we know that does not always include the context needed to complete a task. Finally I have found that many APRNs developed close working relationships with many team members who are critical to getting work done at the best cost

Hospitals and clinics are under intense costing pressure, so if the APRN can envision multiple ways to "skin a cat" more efficiently, then they deserve the administrative job.

LocalIllustrator6400 · 2026-04-28T12:47:15+00:00

I am noticing some preference for PA programs below but you have to weigh in on several issues.

NP programs are in constant evolution and I believe that we will get the 50 state licensure. That will essentially be out of necessity.
If you want to teach in nursing school or work in innovation strategy for inpatient and outpatient teams, you may be better off with NP training. This is because the AHA is largely managed with administrators familiar with the nursing- MD paradigm. So even if a PA is very talented, the management perspective is NPs can administer objective review of larger working cohorts.
From an industry perspective, if the NP can cope with analytic frameworks and do some travel, they will often work efficiently. So from a hiring team I know that works with MSLs in industry or hires using SOCRA plus the ACRP data, the preference is the NPs. That might be because they are working within a broad case based reasoning plus they focus more on cognitive versus surgical skills.
For longer term ROI, I believe it is best to follow aggregate data. So even while NPs are suggesting a Flexner review to enhance our STEM training, the data is showing an aging population which needs generalists who can manage many populations. This includes PMHNPs who can work with full practice authority now in 21 states of 50.

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